Pvt. Manning to Get Transferred? How Gender Change Works

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U.S. Army Pvt. Chelsea Manning, who was sentenced last August to
35 years in military prison after being convicted of releasing
highly sensitive U.S. military secrets to Wikileaks, may get the
OK from the Pentagon to be transferred to a civilian facility to
undergo gender reassignment therapy, according to news reports.

Reportedly, Defense Secretary Chuck Hagel has approved an Army
request to "evaluate potential treatment options for inmates
diagnosed with gender dysphoria,"
The New York Times reports.

Manning, formerly called Bradley, announced that she was a female
named Chelsea and would like to undergo hormone therapy to
transition to a woman, less than a day after her sentence was
handed down. The request put the Defense Department in a bind as
transgender people are not permitted to join the U.S.
military and Manning couldn't be discharged while in prison,
reports Breitbart.com. (Military prisons, as such, do not
provide gender reassignment treatment.)

So what's in store for Manning during the transition to a female?

The military has not released a therapy plan, but according to
Breitbart, Manning had suggested they consider three types of
treatment: real life experience, which wouldn't really work in a
prison but would involve Manning living as a woman without any
medical intervention; hormone therapy, which doesn't involve any
genital or other surgeries; and
sex reassignment surgery. [ How
Gender Reassignment Therapy Works (Infographic) ]

Gender reassignment, sometimes called sex reassignment, can be
performed for numerous reasons and can involve various
procedures. People who are born with ambiguous genitalia —
internal and/or external sex organs that display characteristics
of both male and female sex organs — are often assigned a gender
shortly after birth that they later decide isn't right for them.
These people may choose to have surgery that will give them the
sex organs of their chosen gender.

Sex reassignment is also an option for people with a condition
known as gender dysphoria, also called gender
identity disorder, or GID, which causes a person to develop a
strong personal identification with the opposite sex. People with
GID — who may be heterosexual, bisexual or homosexual — often
have an interest in altering their genitals and may adopt the
dress and mannerisms typically associated with the opposite sex,
according to the National Institutes of Health. [ Top
10 Stigmatized Health Disorders ]

Manning had been diagnosed with GID, and Manning's struggles with
the condition have been an issue throughout the court-martial
process. Shortly before Manning's arrest in 2010, Manning (who
was openly gay for much of adulthood) sent an email to another
soldier that included a photo of Manning in a blonde wig and
makeup; the email was titled, "My problem," according to
ABC News.

People with GID may also live with depression, anxiety and
feelings of isolation. According to several accounts of Manning's
life, Manning frequently complained of feeling desperate and
isolated, due in part to the U.S. military's "Don't Ask, Don't
Tell" policy toward gays and lesbians.

Sex reassignment or "sexual transitioning" usually involves a
team of experts, beginning with mental health professionals who
conduct psychological evaluations, counseling sessions and
screenings to determine if a diagnosis of GID is appropriate.

Hormone therapy under the guidance of an endocrinologist is
another essential component of sexual transitioning. Estrogen
therapy will suppress male characteristics and encourage the
development of female characteristics for male-to-female
candidates such as Manning. Because estrogen therapy doesn't
remove facial or body hair, electrolysis is usually required.

Hormone therapy may begin after, or be concurrent with, a period
known as a "testing" or "real life," during which the individual
lives openly according to his or her identity, though that option
is impractical for a person in prison. This period may last from
several months to two years or more. Because of the emotional and
behavioral changes that occur during hormone therapy, it's
critical that psychological counseling needs are addressed
throughout this period and the whole sexual transitioning
process.

If male-to-female genital reconstructive surgery is chosen,
estrogen treatment temporarily stops a few weeks before surgery
because hormone treatment can interfere with blood clotting. The
operation can preserve genital sensation by using the head of the
penis to create a clitoris, and the scrotum can be used to create
labia (the testes are removed). After the operation, acrylic
inserts known as dilators are used during healing to maintain the
opening of the new vaginal canal.

The entire process for male-to-female reconstructive surgery may
require two or more operations, plus regularly scheduled
assessments and checkups over a period of years; hormone
treatment continues for life. Some people may also choose to have
breast implants, tracheal shaving to minimize the size of the
Adam's apple, and other cosmetic procedures.